Provider Demographics
NPI:1851496137
Name:FEATHERSTONE, SCOTT L (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:FEATHERSTONE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-1328
Mailing Address - Country:US
Mailing Address - Phone:208-726-8272
Mailing Address - Fax:208-726-5848
Practice Address - Street 1:333 MAIN STREET SOUTH
Practice Address - Street 2:SUITE 110
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-726-8272
Practice Address - Fax:208-726-8272
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD38021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-5805506OtherTIN